National Right to Life, Family Research Council, and other anti-abortion organizations have been enthusiastically spreading the word about a study published in the New England Medical Journal showing that a fetus can be viable if born at 22 weeks gestation with advanced medical intervention. A New York Times article about the study was very clear that survival was for a “tiny minority” and that 24 weeks remains the medically and scientifically accepted point of viability. Nonetheless, as all sides in politically polarized issues tend to do, abortion opponents have focused on sharing the headline of the study and not the details. Although coincidental, the publication of the study is perfectly timed with the U.S. House of Representatives passing the 20-week abortion ban, which the Senate will now consider.

Predictably, those who oppose abortion see the study as the proof needed to ban late term abortions, also suggesting that viability age should be lowered. They are appealing to our hearts through survival babies, giving the false impression that at 22 weeks most fetuses can survive outside of the womb. Many who believe that late term abortions must be legally available might even agree with them if the study was conclusive. It is not.

There are important medical-scientific limitations to babies born before 24 weeks. When pregnant women either go into labor early or a medical complication otherwise comrpomises the pregnancy, doctors discuss available medical interventions and the prospective outcomes of each on the fetus. Not all hospitals have the technology or equipment most able to produce a live birth and not all parents choose to have those interventions. Indeed, it is those very women who may choose a late term abortion to save their own lives or spare their wanted child a life of poor health. Much as they felt joy at being pregnant, life offered them a heartbreaking complication. No one has the right to judge the decision they make, certainly not Congress or political opponents of abortion.

In a column for the Daily Beast, Cornell Professor of Pediatrics Jeffrey Perlman noted in more eloquent terms that the study had serious biases and design flaws and should not lead to lowering the age of viability. For that to make sense, a randomized study with and without medical intervention would be necessary. Perlman also pointed out that the research would have to account for a range of factors, such as gender differences in fetal development and accurate estimates of the age of the fetus to name a couple.

I am personally very grateful for the medical advances that have made it possible for premature babies to survive and live healthy, productive lives. I have significant reservations about the use of technology to force life too early to ensure health and quality, just as I do with sustaining life too long when people are confined to a bed with no consciousness and only technology allowing them to breathe. All of us know of children born with disabilities or conditions that require lifelong care. That happens and to full term as well as premature babies. Families accept and embrace the children, adjusting and growing with the child. The acceptance that society places on these children and the value they place on supporting them and their families is evident through public policies, including the Americans with Disabilities Act and various educational reforms.

If a 22-week-old fetus can receive medical assistance and survive, how should medical experts and ethicists respond in the future, if at all, to the prospect of lowering the stage of viability if technology continues to advance? Are we concerned about the financial and social/personal costs associated with using the technology? There are high costs for the medical technology and there are high costs to care for babies born so early that they must receive medical care throughout life however long or short. What about 22-week gestational stage babies born addicted to drugs? Are we going to complain about the public assistance their moms receive? Will Congress thwart programs that support the care for these babies?

For pregnant women in the wrenching situation of unexpectedly delivering a 22-week-old fetus, this study might offer hope if they happen to be at a hospital with the technology and expertise to offer medical intervention that might allow survival of the fetus. For other pregnant women, if this study is improperly used for political gain, and it already is**, instead of hope, it will further erode their options to make decisions they consider best for them and the baby they wanted and may even allow a physician to place priority on the life of the fetus over the woman. Which life is more important?

Instead of having implications for late term abortions and viability, the real issues to come from the study involve ethics and social support. A 22-week-old fetus is not naturally viable. An abortion at 20-22 weeks gestation may well save a woman’s life or spare a baby a life of pain. Nothing has changed in that regard.

** 5/15-15 update: Political misuse of the study has begun. See http://black.house.gov/press-release/rep-black-lauds-upcoming-house-vote-pain-capable-unborn-child-protection-act and http://www.nytimes.com/2015/05/15/opinion/an-abortion-bans-bogus-arguments.html?_r=0

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18 Responses to “Late Term Abortion and 22-Week-Old Fetus Viability”

Good piece, Kimmie. The action of the House of Representatives yesterday is pure political posturing. Indeed, one of the leaders of the anti-abortion movement said as much, nothing that they now had a vote to point to in the Presidential race. The Senate won’t pass it but in the unlikely event that they do, then Obama will veto it. So, it’s just a crock and a waste of time. On the other hand, maybe it’s not! Like the ole “partial birth abortion” debate, what this does is force people to focus on the humanity of the unborn, on those much yuckier (a medical term) abortions that many more people are uncomfortable with. Heck, I’ve seen the by products of such abortions and it’s not a pretty sight, believe me.

I agree with your assessment on the political theater Pat although I keep holding out hope that one day when Republicans say that they want less government, they will include the private lives of women.

Late term abortions are not pleasant to see, that is for sure. Can you even imagine how some women making that choice must feel? I had a friend years ago who made the decision to abort late term after learning that certain organs had formed outside of her much-wanted baby’s body. There was no in-utero surgery that could fix things. She and her husband delayed making the decision as they visited a few different specialists looking for possible solutions and planning to continue the pregnancy regardless if it meant a child with ongoing health care needs. It was not to be.

Here’s where the pro-choicers have problems, however: women can (and do) get abortions up to 24 weeks and they do not have to have a “compelling” reason (i.e., fetal defects, life endangerment, etc.). What the pro-lifers are great at reminding everyone that that means that a woman can abort a perfectly healthy fetus at that point and, while they may technically be a “fetus” to pro-choicers, they are pretty well developed although they may not be viable if removed from the womb. It’s a tough one, a real tough one.

I agree Pat, although I have not had the personal experience of a patient requesting one that late for any reason other than life/health issues of mom or fetus, incredibly young age of the mom, or as a preemptive to a probable health issue revealed through other testing. Pro-choice people make a mistake, in my view, when they deny that it happens because it does, thankfully not likely with much frequency if the data submitted to health departments is accurate.

My reading is that DC lawmakers are focused on 20 weeks as the limit since this is when they claim the fetus can experience pain. Why risk challenging R-v-W on viability grounds until the Supreme Court is stacked in their favor, which could be before 2020 if the Republicans win in 2016 and Ginsburg and Kennedy retire. But as far as I know the pain issue has never been addressed by the SCt, so it is a direction they can go now. Only Kennedy on the present court needs to be persuaded.

Yes, David, “pain” was the premise of the bill passed by the House last week. Thank you for referencing that point. Once the study about 22-week-old fetuses surviving was published, in some circles, the prospect of lowering the stage of viability was amplified. No matter the details, realities, and limitations of the study, I think that the more passionate anti-abortion advocates seized it as an opportunity of sorts. At this juncture, I cannot imagine it getting far if in fact they attempted to introduce legislation to lower the stage of viability.

It is my understanding that the claims of fetal pain are not valid at 20 weeks. If that is so, then, once again, the DC lawmakers are operating on misinformation fueled by misogyny and their own special brand of ideology.

If they were so concerned about pain, perhaps they might consider the horrors inflicted on neonates, who enter and leave this world prematurely. As one NICU nurse reported, infants born at 22-23 weeks gestation have a 1-10% chance of survival, with 95% suffering profound neurodevelopmental impairment. These NICU heroics look more like obscene medical experiments where infants drown in their own blood or die from necrotic and septic intestines or lose skin and muscle after an intravenous line infiltrates in their leg, exposing a patella or losing an ear due the a scalp vein intravenous. It really is a “little shop of horrors” in the NICU.

If they were so concerned about pain, perhaps they might spend research dollars to understand how to avoid premature births.

If they were so concerned about pain, they might work to improve maternal health care in the United States, now 60th in the world.

But I don’t think they concern themselves with the pain of others. They concern themselves with stopping abortion. Some might even go so far as to claim that they concern themselves with their war on women.

It indeed seems that legislators have made conclusions about fetal pain – not doctors or scientists. The same legislators that vote against funding for maternal healthcare programs and research.

You are correct that the concern is to stop abortion. There is so much more that needs attention, it is a real shame that they choose to put their energy into something that is ultimately none of their business.

The anti choice crowd loves spewing fear narratives that lack any shred of truth and any shred of decency toward the humanity of women. Their work simply demonstrates that they are evil, ignorant and untrustworthy.

Good news from the polls that should ultimately impact reproductive health care access and laws:

From a recent Gallup poll, half of Americans consider themselves “pro-choice” on abortion, surpassing the 44% who identify as “pro-life.” This is the first time since 2008 that the pro-choice position has had a statistically significant lead in Americans’ abortion views.

Also, from Gallup, a poll shows Americans are more likely to say that gay sex is morally acceptable, that divorce is acceptable, that extramarital affairs are acceptable, that physician-assisted suicide is acceptable, and even that cloning animals or human beings is acceptable.

Americans’ support for the law recognizing same-sex marriages as legally valid has increased yet again, according to a spring 2015 Gallup poll, now at 60%. Marriage equality advocates have had a string of legal successes over the past year, most recently this week in Pennsylvania and Oregon where federal judges struck down bans on gay marriage.

And in a Pew Poll, individuals were asked to choose which statement they believe to be true: Society is better off if people make marriage and having children a priority, or society is just as well off if people have priorities other than marriage and children. Some 46% of adults chose the first statement, while 50% chose the second statement.

And looking to the religious landscape, Pew found the Christian share of the U.S. population is declining, while the share of Americans who do not identify with any organized religion is growing. These changes affect all regions in the country and many demographic groups.

“Also, from Gallup, a poll shows Americans are more likely to say that gay sex is morally acceptable, that divorce is acceptable, that extramarital affairs are acceptable, that physician-assisted suicide is acceptable, and even that cloning animals or human beings is acceptable.”

Alice, suppose Gallup soon finds out that Americans are more likely to say that adult sex with girls or boys below age 10 is morally acceptable, that the physician-assisted killing of parents or children is acceptable, and that marriages between humans and other animals are morally acceptable, would those also be “good news from the polls”?

I know this is an old article but very relevant as if today in 2019.I am one of the Mother’s who had to decide, decide whether I took away from my 2 kids who were alive and needed me and a husband, a job etc to follow a pregnancy that 1st of all, we knew we were just waiting to see if my body passes her or what. We KNEW without a doubt after 4 diff specialists opinions that she would not ever live. My mind went straight to Pantology of Cantrell means she will never live more then a minute or 2 at birth, only know such extreme pain and suffering and I as her Mother who already loved her so much would never even get to hold and console her or comfort her at all. How would that ever been fair to my baby?! and how could it ever been fair to my 2 alive small kids who knew Mommy was pregnant but not bring a baby home. Yes that happened everyday but why add that kind of grief to them? I have had so many down me for this. very close family, friends, strangers. This whole debate makes me feel so attacked again and so sorry for these other ladies. In this case we are not monsters. we are MOTHER’s trying to do whats best for our babies!